What caused the winter crisis in the NHS?

Low uptake of influenza vaccine, a shortage of nurses, unrealistic expectations of patients, an already high occupancy rate for beds, and the unfortunate timing of outbreaks of both influenza and meningitis over the new year holiday brought the NHS to its knees last week.

The Public Health Labora-tory Service warned last year that vaccine uptake in 1996-7was only 44% among elderly patients and only 12.4% among younger patients at risk. It said that there was a “clear need” to increase uptake, particularly among vulnerable people under 65.

Sir Kenneth Calman, the chief medical officer, wrote to all doctors in August 1998and launched a “flu awareness week” in October to publicise the new policy of offering vaccinations …